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Medical physical exams are part of the daily routine for a doctor, physician’s assistant, or nurse practitioner. If you’re learning how to perform a medical physical exam, it can be overwhelming since you have so many different things to check for in a very specific order. But starting out with more general or pressing concerns, and then moving on to specific systems will help you to keep track of everything. With practice, performing a medical physical exam will become like second nature and you won’t need a reminder for how to do it.

Steps

Part 1

Setting up for the Physical Exam

1

Wash your hands. When you enter the patient’s room, make sure to wash your hands before you make any physical contact with the patient. You can greet the patient first, and then just let them know you need to wash your hands before beginning the exam.[1]

Make sure to use soap and warm water and wash for 20 seconds. Then rinse your hands thoroughly and dry them with a clean paper towel.

2

Introduce yourself to the patient if you’ve never met before. Make sure to provide your preferred name and address the patient by their preferred name. You can ask them what they prefer to be called if you are unsure.

If the patient is someone you have seen before, then you may simply say hello and ask how they are doing.

3

Ensure that the patient is comfortable. If the patient is not already in a gown, politely instruct them to change and then give them some privacy to do so. Then, knock and reenter the room when the patient is changed. Ask the patient to sit or lie down on the examination table depending on what is most comfortable for them.[2]

Make sure there’s enough light in the room to see the patient well.

Check to see if the room is quiet enough that you can hear the sound of the patient’s breath.

Eliminate any hazards, such as wires or other items near the examination table that might prevent you from moving freely around it.

4

Find out if you need to attend to a specific health concern. If the patient has come in for a general physical exam, then you will need to evaluate their overall health to check for any potential problems. However, if the patient has come in with a specific complaint, then you should focus on this complaint first.[3]

For example, if the patient has a bad cold and cough that has lingered for more than a couple of weeks, then you would focus your attention on their respiratory system.

5

Ask the patient about their medical history. Go through the patient’s medical history with them and update it as needed. Make sure to pay special attention to any parts of their medical history that might have something to do with their chief complaint.[4]

Tip: If possible, add this information to your notes as you go so you don’t forget anything.

Taking Vitals and Noting General Appearance

Tip: You may be able to skip the vitals if a nurse or medical assistant has already done this for you. However, if the findings were unusual, then you may need to retake them.

2

Take the patient’s radial pulse. After taking the patient’s blood pressure, take their radial pulse, which is located in their wrist. Press your index and middle finger against the vein to locate the pulse, then count the beats for 1 minute.[6]

3

Count the patient’s breaths per minute. Instruct the patient to breathe normally while you count the number of breaths they take in 1 minute. Count 1 breath each time the patient inhales and exhales. Do not count the inhalations and exhalations separately.[7]

With practice, you should be able to count respirations while taking a patient’s pulse.

4

Assess the patient’s general appearance, hair, skin, and nails. After you have some experience, you may be able to complete this part of the exam while you are taking the patient’s vitals. Note if he patient appears well-groomed. Check to see if their hair, skin, and nails look healthy. Make sure to note any unusual physical signs including:[8]

Muscle pattern

Hair distribution

Odors

Movement and coordination

Part 3

Examining the Head and Neck

1

Examine the patient’s eyes for general appearance and reaction. Look at the patient’s eyes and note the appearance of the corneas, sclera, conjunctiva, and iris. Check the pupils for accommodation, reflexes, and any irregularities. Then, check their visual field, acuity, extraocular movements, and corneal reflex.[9]

You may also ask the patient if they are having any issues with their vision.

2

Look at the external and internal parts of the patient’s ears to check for issues. Check the patient’s pinnae and periauricular tissue, which are the parts of the ear outside of the patient’s head. Then, use the otoscope to look into the patient’s ear. The tissues should appear pink and healthy inside and outside of the patient’s ears with no signs of fluid or excess earwax buildup.[10]

You may also ask the patient if they are having any issues with their hearing.

3

Perform the Weber and Rinne test if the patient has hearing problems. The Weber and Rinne test uses a tuning fork to check for unilateral hearing. Strike the tuning fork and then place the tuning fork’s handle against the patient’s head just above their forehead. Ask them which ear they hear the sound in the loudest.[11]

If the patient has normal hearing, they should report that they hear it equally in both ears. If they have hearing loss, they will report not hearing it as loudly in the affected ear.

4

Check the patient’s eyes using the otoscope. Dim the lights in the exam room, and then use the otoscope to look in the patient’s eyes through their pupils. Pay special attention to the retina, optic disc, arteries, vessels, media, cornea, lens, and macula lutea.[12]

Ask the patient if they get regular eye exams.

5

Inspect the patient’s nasal passages. Attach the nasal speculum to the otoscope and look into the patient’s nostrils. Check for the present of pink, healthy looking mucous membranes.[13]

You might also ask the patient if they have any issues with their sense of smell, allergies, or other related problems as you inspect their nasal passages.[14]

6

Examine the mouth, tongue, teeth, and oral mucosa. Note any dental issues, such as decay, dental work, or noticeable issues with their bite. Then, check the pharynx and assess cranial nerves IX, X, and XII to see if they are functioning properly.[15]

You might also ask the patient if they see a dentist regularly.

7

Look at the patient’s face to check for symmetry. Ask the patient to smile, frown, and open their mouth to see if their face is symmetrical when they do so. This will allow you to assess the function of cranial nerves V and VII.[16]

Tip: You can also assess this when you first greet the patient if they smile at you when you enter the room.

8

Check the lymph nodes and salivary glands. Gently palpate the lymph nodes and salivary glands by pressing on them. Push down on the skin by about 1⁄2 in (1.3 cm). The lymph nodes and salivary glands are located on the underside of a person’s jaw.[17]

Signs of problems with the salivary glands or lymph nodes may include pain when you palpate them, hard spots on the glands, or swelling.[18]

9

Locate and palpate the patient’s thyroid gland. The gland is shaped like a butterfly with its wings outspread, and it is located at the front, center of the neck, just above the collar bone. Note any irregularities in its size or shape.[19]

For example, if the patient’s thyroid gland is oversized or has a palpable nodule on it, then this would require further investigation.

Part 4

Inspecting the Torso

1

Examine the epitrochlear and axillary nodes. The epitrochlear nodes are located on the inside of the arm just above the elbow. The axillary nodes are just below the armpits. Locate these areas and palpate them gently to check for enlargement or signs of infection, such as redness, swelling, or tenderness.[20]

This part of the medical physical exam is often skipped unless a problem is suspected.

Tip: You may want to put on gloves to palpate the axillary nodes since they are located right below the armpits and are likely to be damp from sweat.

2

Listen to the patient’s heart with a stethoscope. Place the stethoscope over the patient’s heart and listen to it beating for about 1 minute to check for any abnormalities.

You may also check for bruits at this time if you suspect a problem. Place the stethoscope over the patient’s carotid arteries 1 at a time and listen for a turbulent whooshing sound to detect a bruit.[21]

3

Listen to the patient’s lungs with the stethoscope. As you listen to their lungs, check for any visible deformities in the patient’s chest.[22] If you notice a difference in the breath sounds between the right and left sides, then this is notable.[23]

While you are listening to the patent’s lungs, observe them for signs of straining. For example, if you notice the person is using their whole chest to help them breathe, then this may indicate a respiratory issue.

4

Check the patient’s distal strength by having them squeeze your hands. Hold out your hands to the patient and ask them to squeeze them tightly. You should feel an equal amount of pressure on both hands when the patient does this.[24]

If the patient cannot squeeze your hands tightly or if they seem to be much stronger on one side than the other, then there may be an issue that requires further investigation.

5

Observe the patient’s proximal strength by watching them stand up. Ask the patient to stand up from a seated position. If the patient can stand up on their own without using their hands to push off of the chair, then they have good proximal strength. However, if the patient needs help getting up, or needs to grab onto something to stand up, then they do not have good proximal strength.[25]

Proximal strength may decrease as a person ages, but if a young, relatively healthy patient has poor proximal strength then this may be a cause for concern.

6

Listen to the abdomen for bowel sounds and bruits. Ask the patient to lay down and lift up their shirt or gown to reveal their abdomen. Drape a sheet over them if needed to cover their private areas. Then, use the stethoscope to listen to all 4 quadrants of their abdomen. Bowel sounds should be present in all 4 quadrants. Then, move on to the renal arteries and listen with the stethoscope to check for bruits.[26]

A bruit makes a turbulent whooshing sound, so it should be easy to detect.

7

Percuss and palpate the abdomen to check the spleen and liver. Use your hands to feel the patient’s abdomen. Press down gently with your fingertips by about 1 in (2.5 cm) to palpate, and tap the abdomen gently with your fingertips to percuss it. Locate their liver and spleen to check that they are normal size.[27]

If the liver or spleen feels enlarged, this will require further investigation.

Tip: Always palpate and percuss the abdomen after you listen for bowel sounds and not before. This is because palpating and percussing the patient’s abdomen can alter bowel sounds.[28]

Part 5

Conducting Optional Parts of the Exam

1

Perform a pelvic exam if the patient is female and has related concerns. You may need to perform a pelvic exam if the patient is in for an annual well-woman exam. If her concerns are unrelated, or if she has her pelvic exam done at her gynecologist, then you can skip this part of the exam.[29]

Instruct the patient to put her feet into the stirrups for this part of the exam and drape a sheet over her to ensure her comfort.

Gather what you will need before starting the exam, such as a speculum and items for collecting a sample from the patient’s cervix.

Tip: Make sure to put on gloves before beginning this portion of the exam since you may come into contact with bodily fluids.

2

Examine the breasts if the patient is female and has concerns. This part of the exam may also be optional depending on the purpose of the patient’s visit and whether or not she has this done at her gynecologist. Look at the breast tissue to check for any irregularities, such as redness, dimpling, or shiny areas of the skin. Then, palpate the breasts to feel for any abnormalities in the tissue.[30]

Ask the patient if they perform regular breast self-exams to check for issues. If not, instruct them on the benefit of doing these checks.

3

Do a rectal exam and collect a sample if the patient is having issues. If the patient has come in complaining of blood in the stool, pain on defecation, or other related digestive issues, then you may need to perform a rectal exam and collect a stool sample to check for occult blood.[31]

Tips

Make sure to communicate with your patient throughout the exam. Tell them what you are going to do before you do it, ask them to change position as needed, and politely instruct them to do other things as needed for the exam.

Always wear gloves and other personal protective equipment as required for the type of exam and to protect yourself against any transmittable diseases.

Article Info

wikiHow is a “wiki,” similar to Wikipedia, which means that many of our articles are co-written by multiple authors. To create this article, 25 people, some anonymous, worked to edit and improve it over time. Together, they cited 31 references. This article has also been viewed 78,810 times.